Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations

J Cardiovasc Transl Res. 2016 Apr;9(2):145-52. doi: 10.1007/s12265-016-9680-6. Epub 2016 Feb 16.

Abstract

We evaluated the clinical outcome of patients with moderate/severe aortic stenosis and significant coronary disease not treated according to guidelines, recommending combined aortic valve replacement (AVR) and coronary artery bypass grafting (CABG). From 2002 to 2010, we assessed death up to 5 years in 650 patients with moderate/severe aortic stenosis and at least one coronary lesion (>50 %): 23 % were treated conservatively (MT), 17 % with percutaneous coronary intervention (PCI), 11 % with AVR, and 49 % with combined CABG and AVR. At a median follow-up of 58 months, overall death decreased over the groups (MT, 68 % vs. PCI, 44 % vs. AVR, 34 % vs. CABG and AVR, 23 %, p < 0.01). Compared to the MT group, Cox regression analysis adjusted for potential confounders showed significantly reduced mortality in the PCI, AVR, and CABG and AVR groups. When combined CABG and AVR is not feasible, PCI or AVR alone still improves significantly long-term survival as compared with MT alone.

Keywords: Aortic valve disease; Coronary artery disease; Coronary bypass grafts; Percutaneous coronary intervention.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis / complications
  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / mortality
  • Aortic Valve Stenosis / surgery*
  • Cardiovascular Agents / therapeutic use
  • Chi-Square Distribution
  • Coronary Artery Bypass / adverse effects
  • Coronary Artery Bypass / mortality
  • Coronary Artery Bypass / standards*
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / surgery*
  • Delivery of Health Care / standards*
  • Female
  • Guideline Adherence / standards
  • Heart Valve Prosthesis Implantation / adverse effects
  • Heart Valve Prosthesis Implantation / mortality
  • Heart Valve Prosthesis Implantation / standards*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Percutaneous Coronary Intervention / standards
  • Practice Guidelines as Topic / standards*
  • Practice Patterns, Physicians' / standards*
  • Proportional Hazards Models
  • Registries
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome

Substances

  • Cardiovascular Agents